There is nothing healthier for the gums than to have natural tooth structure resting against it. Removing that tooth structure and replacing it with a crown can make cleaning and maintaining the restored tooth much more challenging, especially if that crown is ill-fitting, has open or overhanging margins, rougher surfaces, or open contacts that can attract and trap food. Most times there is also nothing more natural and esthetic than being able to maintain the original size, shape, anatomy, and color of the tooth.
So why are dentists telling their patients that, if you have had a root canal then you will need a crown? They say this like it is an automatic thing, an absolute rule or some sort of dental law. This defies common sense! There are no absolutes. Every person is an individual and every situation is different. What might be indicated for one person may be the wrong thing to do for another person.
Picture this… imagine you had a very large old silver-mercury (Amalgam) filling in the center of your big molar tooth and it was failing, with a deep cavity all around it and you had to have a root canal because the nerve became infected. The root canal was later completed, and you were left with about 1-2 mm of good tooth structure all around where the old filling and cavity was. What is there still looks like your tooth… same size, and shape, just hollowed in the center. You want to keep this tooth structure because the gums are healthy around it. The adjacent contacts that you floss are intact, and food does not get trapped, and you like the look and color of your tooth.
An average dentist, who went through traditional dental school, would most likely suggest preparing that tooth for a crown after root canal therapy, which translates to removing most of the good tooth structure that you have left. They would cut away that remaining 1-2 mm of enamel that you had, stick a post in the root recently filled with that root canal filling, and have a crown fit around that post and core with not much solid tooth structure to hold on to. Teeth with posts are much more likely to fracture. And, if a tooth with a post and crown fails, it is often a catastrophic failure that would require an extraction and bone graft followed by an implant and new implant crown.
You do, however, have another option. There is another way that not everyone knows about yet. A new, more biological approach to dentistry. With this biological approach to dentistry, one would be able to scaffold the inner aspects of the tooth with bio-emulating materials that restore the internal connections and durability of the tooth and then utilize the special layering techniques, adhesive protocols and biocompatible materials that are advocated in Biomimetic Dentistry to replace what was missing and to mimic the natural biology and characteristics of the tooth structure being replaced. This can often be performed in one visit and can save your valuable time, money, and your good tooth structure.
Now that you know this…which form of dentistry would you prefer to have performed in your mouth? Now there may be times when doing a crown after a root canal is truly the best choice. If there is a tooth that is severely cracked and needs the full coverage support of a crown, then it may be indicated in that situation. When an old crown is being replaced, then yes, it makes sense to create another new crown in its place. Often an onlay or overlay (partial coverage indirect restorations) can be utilized instead of a crown after root canal therapy to lend support to thin, weakened cusps and lend stability to the tooth without taking away more good tooth structure from the bottom third of the tooth.
So now let’s ask this question again…Why are dentists telling their patients that if you have had a root canal then you will definitely need a crown? The answer…because this is what is being taught in dental schools and residencies around the world. The next question is, why is this the protocol that is taught to dentists to address a tooth that was treated with a root canal? Why does a tooth with very deep decay close to the nerve get condemned for root canal therapy? Why does that tooth now need to have a post stuck deep down in that root? Why does that compromised tooth now have to be further compromised by removing the remaining tooth structure and be prepared for a crown, which may jeopardize the health of the surrounding gum tissues? The answer…this is a technique that the average dentist around the world can comprehend and practice and utilize most times in this situation, without having to improvise, think outside the box or utilize techniques acquired with further continuing education.
You may choose be treated by an average dentist with cookie-cutter techniques and by someone who does not question the protocols that defy common sense, but then ask yourself, is that what you would really choose to do, if you did your due diligence and had the knowledge you now have? It may be more convenient to see that average practitioner because they are on your plan or located close to you, but is it worth it when it could be more costly down the line? I encourage you to visit our website to learn more about what a Biomimetic dentist, certified in Biomimetic Dentistry, can do to save your tooth structure.
I am very proud to be one of the few certified Biomimetic Dentists and Certified Biomimetic Instructors not only in NYC but in the country. Once my mind was opened to how we can save most teeth from unnecessary root canals and invasive preparations by utilizing the techniques, materials, and protocols of Biomimetic Dentistry and Biological Dentistry, I can never go back to the assembly line protocols that I was taught in dental school years ago. Graduating dental school may be like achieving that Black Belt in Karate, but that is just the beginning. The lessons and learning do not stop at the first degree. There are nine degrees until you become a Master.
If I have spiked your curiosity and you would like to learn more about Biomimetic dentistry, I am always available to you in my office for a consultation (332-334-8290) or you can also feel free to take a look at other articles I have published about this found on my website at https://www.drmarclazare.com/services/biomimetic-dentistry/
Stay tuned for my next blog post: “Why choosing a dentist based on convenience may prove to not be so convenient after all...”